Cohen David J, Reynolds Matthew R
Saint Luke's Mid America Heart Institute, Kansas City, Missouri 64111, USA.
J Am Coll Cardiol. 2008 Dec 16;52(25):2119-26. doi: 10.1016/j.jacc.2008.09.018.
In developed nations, health care spending is an increasingly important economic and political issue. The discipline of cost-effectiveness (CE) analysis has developed over several decades as a tool for objectively assessing the value of new medical strategies, by simultaneously examining incremental health benefits in light of incremental costs. The underlying goal of CE research is to allow clinicians and policymakers to make more rational decisions regarding clinical care and resource allocation. This review will provide the reader with an understanding of the theoretical underpinnings of CE analysis, the types of analyses commonly performed and reported in the medical literature, some important strengths and weaknesses of different analytical approaches, and key principles in the interpretation of CE results. Key principles reviewed include the impact of analytic perspective, the importance of proper incremental comparisons, the effect of time horizon, and methods for exploring and describing uncertainty. Illustrative examples from the cardiology literature are discussed.
在发达国家，医疗保健支出日益成为重要的经济和政治问题。成本效益（CE）分析学科在过去几十年中不断发展，成为一种通过结合增量成本来同时考察增量健康效益，从而客观评估新医疗策略价值的工具。CE研究的根本目标是让临床医生和政策制定者在临床护理和资源分配方面做出更合理的决策。本综述将使读者了解CE分析的理论基础、医学文献中常见的分析类型及报告方式、不同分析方法的一些重要优缺点，以及CE结果解读中的关键原则。所综述的关键原则包括分析视角的影响、恰当增量比较的重要性、时间范围的影响以及探索和描述不确定性的方法。文中还讨论了来自心脏病学文献的实例。
